
<div class="am-u-sm-12 widget main-w">
	
	<form class="am-form-inline tpl-form-border-form" action="" data-ajax="1" data-check="1">
		{if $Think.get.insurance_id}
		<input type="hidden" class="tpl-form-input" name="insurance_id" />
		
		{/if}
		<div class="am-u-sm-10">
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">保险公司名称： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="insurance_name" data-check='require' data-msg="公司名称不能为空" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			
			
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">保险公司负责人： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="charge_person" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">保险公司联系电话： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="contact_number" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">保险公司规模： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<select name="scale">
								<option value="1">小型</option>
								<option value="2">中型</option>
								<option value="3">大型</option>
								
								
							</select>
						</div>
					</div>
				</div>
			</div>
			
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">保险公司地址： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="address" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">合同有效期起： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="start_date" id="startDate" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">合同有效期终： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="end_date" id="endDate" value="" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">备注： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<textarea class="remark" rows="5" name="remark"></textarea>
						</div>
					</div>
				</div>
			</div>
			
			<!--<div class="am-u-sm-12 cl-p" style="margin-bottom:10px ;margin-top: 10px;">
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">照片： </label>
					<div class="am-u-sm-8 cl-p">

						<div class="am-form-group am-u-sm-3 cl-p">

							<div class="am-u-sm-10 am-margin-top-xs cl-p">
								<div class="am-u-sm-12 cl-p">
									<div class="am-form-group file-w">
										<div style="width: 150px;height: 100px;">
											<img class="fileimg" data-magnify="1" src="{if $item.license}{:CxImg($item.license)}{else/}{$static_dir}/assets/img/noimg.gif{/if}" style="width: 100%;height: 100%;" />
											
										</div>
										<button type="button" data-type='file' class="am-btn am-btn-danger am-btn-sm "><i class="am-icon-cloud-upload"></i> 添加维修厂图片</button>
										<input type="file" name="license" data-type='img' style="display: none;">
									</div>
	
								</div>
								

							</div>
						</div>
					</div>
				</div>
				<div class="am-u-sm-12 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">营业执照照片： </label>
					<div class="am-u-sm-8 cl-p">

						<div class="am-form-group am-u-sm-3 cl-p">

							<div class="am-u-sm-10 am-margin-top-xs cl-p">
								<div class="am-u-sm-12 cl-p">
									<div class="am-form-group file-w">
										<div style="width: 150px;height: 100px;">
											<img class="fileimg" data-magnify="1" src="{if $item.license}{:CxImg($item.license)}{else/}{$static_dir}/assets/img/noimg.gif{/if}" style="width: 100%;height: 100%;" />
											
										</div>
										<button type="button" data-type='file' class="am-btn am-btn-danger am-btn-sm "><i class="am-icon-cloud-upload"></i> 添加图片</button>
										<input type="file" name="license" data-type='img' style="display: none;">
									</div>
	
								</div>
								

							</div>
						</div>
					</div>
				</div>
			</div>-->
			<div class="am-u-sm-12" style="margin-bottom:10px;">
				<div class="am-u-sm-4">&nbsp;</div>
				<div class="am-u-sm-4">
					{if $Think.get.insurance_id}
					<button type="button" class="am-btn am-btn-sm am-btn-primary tpl-btn-bg-color-success keep2">保存</button>
					{else/}
					<button type="button" class="am-btn am-btn-sm am-btn-primary tpl-btn-bg-color-success keep">新增</button>
					{/if}
					<a href="{:url('index')}" type="button" class="am-btn am-btn-sm am-btn-danger tpl-btn-bg-color-success">返回</a>
				</div>
				<div class="am-u-sm-4">&nbsp;</div>
			</div>
		</div>
		
	</form>
</div>
<script type="text/javascript" src="http://webapi.amap.com/maps?v=1.4.2&key={:config('base.mapkey')}&plugin=AMap.Driving,AMap.Scale,AMap.OverView,AMap.ToolBar,AMap.MouseTool,AMap.DistrictSearch,AMap.MarkerClusterer"></script>
<script src="//webapi.amap.com/ui/1.0/main.js?v=1.0.11"></script>